A group of specialists from the Tyumen region completed a professional training on Maternal and Child Health, in Sacramento, California, from May 21st through 11 June 2009, under the auspices of the Community Connections – Russia program. The group consisted of health promotion specialists, managers of medical and treatment facilities, and doctors from Tyumen, Nizhnaya Tavda, Tobolsk, Ishim and Surgut. The delegates were hosted by the Lift the Children  international agency in the United States.

The training program included the following:

• an introduction to the American health system and the principles of maternity and child health services;
• programs and concepts in support of normal-term pregnancy, childbirth and the health of newborns in the first year of life (obstetrics, family involvement, the joint treatment and care of newborns and their mothers, exclusive breast-feeding, and the prevention of abortion and sexually transmitted diseases, including HIV);
• basic principles in the prevention of HIV-cross-infection from mother to child;
• advice to pregnant women and couples on healthy lifestyles, birthing classes and preparation, and family planning;
• the role of various organizations in the provision of medical, social and educational services in the development and fulfillment of programs in maternity and child health;
• public support and social responsibility in reproduction and child health, and public involvement in problems related to reproductive health;
• the organization of paramedical services and cross-service cooperation;
• experience in the development and implementation of public health promotion programs;
• marketing in social and public services, and media relations.

Under the auspices of the program the group visited both government and private medical services, as well as non-commercial and state organizations (within the Department of Health), all of which are involved in maternity and child health.

A visit to a school in the Sierra Nevada left a strong impression on participants. This school organizes classes for young mothers-to-be, and has established facilities for child-minding and breast-feeding, as well as allowing mothers to leave their children in the care of nursery teachers during lessons. The presence of the state in the care of adolescent mothers-to-be – who, thanks to this support, are able to continue their studies while, at the same time, caring for a child – was  everywhere apparent.

The visit to the Women and Children's Center (Kaiser Permanente Roseville), Sacramento, was remarked on by the delegates as being very important and memorable. It was here that they gained an insight into obstetrics in the United States, and were able to see and evaluate the extent to which the wards were equipped and computerized. Natalya Ivanova, chief medical officer at Maternity Home No. 3, Tyumen, remarked that it was very pleasant to discover the similarities between the work of her health service and that of the American: "At our maternity home we have practically everything they do here – except with regard to the number of staff per patient and the computerization at every work station. I was proud of Tyumen."

The Russian delegates were very interested in the Mercy San Juan Medical Center, ranked among the one hundred best hospitals in the United States. Bryan Gardner, from the hospital's press service, together with employees from the Department for Intensive and Neo-natal Care, led an excursion through various branches of the hospital. Every year, approximately 3,500 babies are born in the Maternity Unit of this medical establishment. This department holds one of the highest rankings for positive outcomes in premature births, and the Department for Intensive and Neo-natal care is considered one of the best in the country. Nadezhda Kazakevich, Senior Specialist at the Department of Health of the Tyumen City Administration relates: "The level of care at the Mercy San Juan Hospital is outstanding: in the space of 27 weeks children recover their full health. It's amazing!"

Without exception, all delegates enjoyed the meeting with specialists of the
non-governmental organization, March of Dimes. According to Irina Antonyuk, deputy chief medical officer at the Tyumen Perinatal Center, the group got surprised by the sheer single-mindedness and high level of professionalism of the American specialists depicted in developing programs for the prevention of premature births.

Galina Moskvina, deputy chief medical officer of the Tobolsk Perinatal Center, outlines her impressions: "I have excellent memories of the meeting with obstetrician Laurel Finta at the UC Davis Medical Center, who gave so much of her time to share her experience with us. As an obstetrician myself, I realized that, in large part, our disciplines and protocols in various obstetric situations are similar, and that our own work in obstetrics is entirely up-to-date. In that facility I saw that there is nothing like the same stringent requirements on sterilization that there are in Russia. In the American clinic, children's diapers are simply washed, they are not put through intensive cleaning. I plan to abandon sterilization: this possibility is currently under discussion at the Tobolsk branch of Rospotrebnadzor (the Federal Service for the Oversight of Consumer Protection and Welfare)."

At the Planned Parenthood family planning center, Judy Linder and Lauren Straker presented the experience of their organization in the United States, including the management and implementation of monitoring of the birth rate, testing for HIV and venereal disease, consultation with HIV-positive patients, pre-natal care, and other medical services.

The Russian specialists were amazed by the high degree of professionalism shown by paramedical staff. A big impression was made on program participants by the socially oriented nature of paramedics' interaction with patients, as well as the work of community organizations and the investment in the management of medical services made by the American public, and, in particular, by the state.

Participants were shown several new practices in working with families, during a visit to the Family Resource Center run by the The Effort organization. This center offers socially vulnerable citizens in Sacramento a wide range of services designed to strengthen family life and promote healthy lifestyles. Of particular interest to the Russian delegates was the opportunity to accompany family advisors from the center on their visits to Russian-speaking families.

A new and interesting experience worthy of further study was the close cooperation between various services (social, educational and so on) involved in the resolution of medical problems. Inna Kilicheva, deputy chief medical officer of the Surgut Clinical Perinatal Center, witnessed the major investment made by community organizations in public health promotion.

Almost all participants were struck by the prevalence of the voluntary movement throughout the U.S.A. A large proportion of Americans are involved in voluntary activity through financial donations, or, more frequently, through giving up their personal time to take part in projects and initiatives. Nadezhda Kazakevich is already bringing to life her own plans for the development of the voluntary movement in Tyumen, and has arranged for medical students to visit socially disadvantaged families during practical classes.

Delegates spent one of their days off at Lake Tahoe, and for many the impression left by this excursion became the most memorable of the whole trip. An opportunity arose for the whole group to take some time out together, to enjoy the outstanding natural beauty, and to engage with the trip organizers. Lake Tahoe is considered one of the most beautiful lakes in the world, and is the highest alpine lake in the United States, with extraordinarily clear water, bounded by the snow-topped peaks of the Sierra Nevada.

Participants' expectations of the program were met in full. The Russian delegates remarked on the intensity and comprehensiveness of the program, and the exhaustive and manifold scope of the systems available for assistance to women and children, at all levels and in all areas of activity. Senior American specialists were quite justifiably proud in demonstrating their medical facilities, and spoke at length about the many technologies available, directly demonstrating their use in various departments, and remaining open to questions and good-natured. Over the course of its three weeks' duration, the program remained intensive throughout, with training conducted at a good (although not excessive) work-rate. Participants were satisfied that there was sufficient time for work and for relaxing on their days off. Organization of the trip was handled extremely well, thanks to host organization director Keith Smith, manager Mary Jennings, and interpreters Alexander and Ksenia.

Accommodation with host families allowed the Russian delegates to learn more about the
day-to-day life of Americans, to gain an understanding of their traditions and culture, and to find some common ground. Inna Kilicheva relates her experience of living with an American family: "We witnessed all kinds of Americans, not just at work but also in their everyday life, and out on the street. A jazz festival, a farming exhibition, a picnic with Katy, a visit to the state capital of California, a trip to the Railway Museum, taking part in Memorial Day, the Sacramento River Cats baseball match – all were beyond praise. I believe that placing delegates with host families enriches the trip through allowing informal interaction, and allowing us to improve our command of the language." The host families, for their part, were concerned to make the Russian participants' trip to America as comfortable as possible.

Getting to know Americans as a single nationality was also an important experience for the Russians. Patriotic, very open, direct, rational, law-abiding – thus were the residents of the United States viewed by the Russians.

For Sergei Gerasimov, chief medical officer at the Ishim City Hospital, the trip acted as a stimulus for self-improvement. He remarked that he had adopted the American style of communication – not interrupting, looking people straight in the eye – and that he is now getting used to this! Other participants confirmed that the professional training had given them inspiration, awakening in them the desire to work and create – and, of course, to improve their English!

Since returning to their homeland, the Russian specialists have been trying to apply in their own work much of what there were able to learn during their time in the United States. For example, Natalya Ivanova is introducing psychological counselling in preparing women for childbirth, through two-hourly family classes, over a period of six weeks – just as they do at the Women's Center at the Mercy Hospital. These classes involve not just an overview of information on giving birth, but also care of the child after birth, contraception, the reaction of significant others to the arrival of a child, and much else. For Nadezhda Kazakevich, Senior Specialist at the Department of Health of the Tyumen City Administration, American experience in leading roundtable sessions and meetings with specialists has proved very useful: and Inna Kilicheva, deputy chief medical officer, is implementing new forms of preventative work at the Surgut Pediatric Center.

Insofar as group participants work in regional medical facilities, and meet and interact at regional conferences, they were all acquainted prior to their trip to the United States. In their collective opinion, they bonded still more closely during their professional training. Olga Pavlova, deputy chief medical officer for pediatrics at the Tyumen region Clinical Hospital, together with other program participants, has brought to life her plan of action, developed while in the United States: "In America we began work on a comprehensive project to reduce infant mortality in the Tyumen region. All kinds of specialists are taking part in this project – obstetricians, gynaecologists, specialists in neo-natal care, paediatricians, social workers, health professionals and others." Participants' plans include organizing a program for the prevention of sudden-death syndrome. The target audience for this project comprises medical specialists, new parents, and families with newborns. Work continues apace: a workbook has been published and educational lectures are being given for mothers-to-be, both during their time in the maternity hospital and just before they go home.

Program participants remember their trip with great pleasure, and are sharing the experience they gained. A meeting has been held at the Tyumen Regional Department of Health, highlighting the results of the trip. Participants from the cities of Surgut, Nizhnaya Tavda, Ishim and Tobolsk have also led meetings and seminars for their colleagues, at which they have discussed various aspects of the program.

"This has confirmed my opinion, yet again, that there's always something to strive for, both personally and professionally. The trip was unforgettable, and so inspiring that I simply wanted to take off!" Such was the evaluation given to the program by one Community Connections – Russia program alumna after completion her participation in the professional training in the United States.